Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association
Open accessAbstract
Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.
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Several previous meta-analyses have investigated the role of SFA restriction for CVD prevention, and these have been cited as evidence supporting the recommendation of SFA restriction by the European Society of Cardiology/European Atherosclerosis Society.
“Several previous meta-analysis have investigated the role of SFA restriction for CVD prevention (26), (27), (28), and these have been cited as evidence supporting the recommendation of SFA restriction by the European Society of Cardiology/European Atherosclerosis Society (29).”
From Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2025) · cites this paper as [27]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredReduction of risk of coronary heart disease by replacement of saturated fat with polyunsaturated fat has been supported by both observational cohort studies and randomized trials.
“In addition, red meat is low in polyunsaturated fat, and reduction of risk of CHD by replacement of saturated fat with polyunsaturated fat has been supported by both observational cohort studies and randomized trials.33”
From Red meat intake and risk of coronary heart disease among US men: prospective cohort study (2020) · cites this paper as [33]
In general, replacing saturated fat with unsaturated fats reduces both total cholesterol and LDL-C and also benefits CVD risk.
“In general, replacing saturated fat with unsaturated fats reduces both total cholesterol and LDL-C and also benefi ts CVD risk.”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [295]
Lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD.
“theAmericanHeartAssociation concluded that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD (295).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [295]
SFAs exert different effects on LDL cholesterol based on their fatty acid chain length.
“SFAs exert different effects on LDL cholesterol based on their fatty acid chain length [9].”
Lauric, myristic, and palmitic acids raise LDL cholesterol, while stearic acid has a neutral effect.
“Although lauric, myristic, and palmitic acids raise LDL cholesterol, stearic acid has a neutral effect [9].”
The primary strengths of our study lie in its rigorous inclusion criteria and the specification of its literature search strategy.
“Compared with those of previous meta-analyses (26), (27), (28), the primary strengths of our study lie in its rigorous inclusion criteria and the specification of its literature search strategy.”
From Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2025) · cites this paper as [27]
The literature search strategy was not described in the AHA presidential advisory by Sacks et al. (27).
“In the presidential advisory of the AHA by Sacks et al. (27), the literature search strategy was not described”
From Saturated Fat Restriction for Cardiovascular Disease Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2025) · cites this paper as [27]
The “CVD Outcomes: Prospective Observational Studies” section identifies the reviews and kinds of studies considered, but the retrieved passages do not describe a database or keyword search strategy. Searches for “search strategy,” databases, and search terms found no decisive passage; under the supplied rubric, that absence alone cannot verify the claim. (LLM, conf=0.65)
Experimental — accuracy not yet measuredA Mediterranean-style eating pattern improves glycaemic control, lipids, and blood pressure.
“A Mediterranean-style eating pattern improves glycaemic control, lipids, and BP.80,81”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [81]
Combining diet and exercise leads to the greatest improvement in physical performance and quality of life and mitigates reductions in muscle and bone mass, particularly in older people.
“this approach also leads to the greatest improvement in physical performance and quality of life, and mitigates reductions in muscle and bone mass, particularly in older people [176].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [176]
Reduced intake of saturated fat is associated with lower plasma cholesterol levels and reduced incidence of coronary heart disease, especially when saturated fat is substituted with polyunsaturated and monounsaturated fat.
“Population-based and prospective epidemiological studies have shown that reduced intake of saturated fat is associated with lower plasma cholesterol levels and reduced incidence of coronary heart disease, especially when saturated fat is substituted with polyunsaturated and monounsaturated fat (33).”
From Health Benefits of the Mediterranean Diet: Metabolic and Molecular Mechanisms (2018) · cites this paper as [33]
Omega-3 polyunsaturated fatty acids are an important part of a diet that supports heart health.
“Omega-3 polyunsaturated fatty acids (PUFAs) are a key component of a heart-healthy diet.”
From Cardiovascular Impact of Nutritional Supplementation With Omega-3 Fatty Acids (2021) · cites this paper as [92]
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Omega-6 fats for the primary and secondary prevention of cardiovascular disease
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“3 [13].”
BackgroundInfluentialEating patterns and food intake of persons with type 1 diabetes within the T1D Exchange
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“19,20 3–8 To date, the relationship between circulating ω 3-PUFA content and cardiovascular events in patients after ACS is not well established.”
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- Authors
- Sacks, F. M., Lichtenstein, A. H., Wu, J. H. Y., Appel, L. J., Creager, M. A., Kris-Etherton, P. M., Miller, M., Rimm, E. B., Rudel, L. L., Robinson, J. G., Stone, N. J., & Van Horn, L. V.
- ORCID
- Venue
- Circulation
- Published
- 2017-07-18
- Volume
- 136
- Issue
- 3
- Pages
- e1-e23
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2625336870
- Cited by
- 1,386
- References
- 139
- Citations by year
- 2026: 125 · 2025: 157 · 2024: 148 · 2023: 161 · 2022: 139 · 2021: 172 · 2020: 165 · 2019: 154 · 2018: 136 · 2017: 27 · 2013: 1
- FWCI
- 13.58
- Type
- journal article
- Language
- en
- Update notices
- correction (2017-09-05)
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- dietary saturated fat, cardiovascular disease, polyunsaturated fat, monounsaturated fatty acids, vegetable oils, refined carbohydrates, fat replacement, LDL cholesterol, atherosclerosis, DASH diet, Mediterranean diet, dietary guidelines, cardiovascular disease prevention
- MeSH terms
- Healthy Lifestyle, American Heart Association, Cardiovascular Diseases, Dietary Fats, Dietary Fats, Unsaturated, Humans, Prospective Studies, United States, Randomized Controlled Trials as Topic, Nutrition Policy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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